Cited by 47Nutrition and Health in AgingClinical Nutrition and GastroenterologyBody Composition Measurement Techniques

Prevalence of malnutrition based on global leadership initiative in malnutrition criteria for completeness of diagnosis and future risk of malnutrition based on current malnutrition diagnosis: systematic review and meta-analysis

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Bian, Wentao, Li, Yi, Wang, Yu, Chang, Li, Deng, Lei, Li, Yulian, Jiang, Hua, Zhou, Ping·2023·Frontiers in Nutrition

Abstract

Background: The proposal of the global leadership initiative in malnutrition (GLIM) criteria has received great attention from clinicians. The criteria are mainly used in the research environment and have the potential to be widely used in the clinic in the future. However, the prevalence of malnutrition and risk of future malnutrition based on a current diagnosis of malnutrition are worth exploring. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed from the earliest available date to 1 February 2023. According to the diagnostic criteria of the GLIM, we analysed the prevalence of malnutrition by directly adopting the GLIM criteria for diagnosis without a previous nutritional risk screening (one-step approach) and by adopting the GLIM criteria for diagnosis after a nutritional risk screening (two-step approach). The main outcome was the prevalence of malnutrition based on the one-and two-step approaches. Secondary outcomes were the future risk of malnutrition based on the GLIM diagnosis, including mortality within and beyond 1 year. primary outcomes were pooled using random-effects models, and secondary outcomes are presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results: A total of 64 articles were included in the study, including a total of 47,654 adult hospitalized patients and 15,089 malnourished patients based on the GLIM criteria. Malnutrition was diagnosed by the one-step approach in 18 studies and by the two-step approach in 46 studies. The prevalence of malnutrition diagnosed by the one-and two-step approaches was 53% (95% CI, 42%–64%) and 39% (95% CI, 0.35%–0.43%), respectively. The prevalence of malnutrition diagnosed by the GLIM criteria after a nutritional risk screening was quite different; the prevalence of malnutrition diagnosed by the Nutritional Risk Screening 2002 (NRS2002) GLIM tool was 35% (95% CI, 29%–40%); however, the prevalence of malnutrition diagnosed by the Mini Nutrition Assessment (MNA) GLIM tool was 48% (95% CI, 35%–62%). Among the disease types, the prevalence of malnutrition in cancer patients was 44% (95% CI, 36%–52%), while that in acute and critically ill patients was 44% (95% CI, 33%–56%). The prevalence in patients in internal medicine wards was 40% (95% CI, 34%–45%), while that in patients in surgical wards was 47% (95% CI, 30%–64%). In addition, the mortality risk within 1 year (HR, 2.62; 95% CI, 1.95–3.52; I 2 = 77.1%) and beyond 1 year (HR, 2.04; 95% CI, 1.70–2.45; I 2 = 59.9%) of patients diagnosed with malnutrition by the GLIM criteria was double that of patients with normal nutrition. Conclusion: The prevalence of malnutrition diagnosed by the GLIM criteria after a nutritional risk screening was significantly lower than the prevalence of malnutrition diagnosed directly by the GLIM criteria. In addition, the mortality risk was significantly greater among malnourished patients assessed by the GLIM criteria. Systematic review registration : identifier CRD42023398454.

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  • The largest meta-analysis was performed in general hospitalized patients, with 47,654 participants.

    “The largest meta‐analysis was performed in general hospitalized patients, with 47,654 participants. 14”

    From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [14]

    The Methods (Data analysis) identify this as a meta-analysis of adult hospitalized patients, and the Results (Search results) report 64 studies with 47,654 subjects. Our copy does not establish that it was the largest meta-analysis. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Malnutrition prevalence was 40%-50% on average in that meta-analysis.

    “Malnutrition prevalence was 40%–50% on average. 14”

    From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [14]

    The Outcomes > Primary outcomes section reports pooled malnutrition prevalence of 39% with two-step diagnosis and 53% with one-step diagnosis. These figures are broadly around the claimed range, but the paper does not report a single average of 40%–50%; prevalence depends on the diagnostic approach. No page number is available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Eight systematic reviews, some with meta-analyses, of predictive validity (mainly mortality as the outcome) were published.

    “Concurrently, eight SRs, some with meta‐analyses, of predictive validity (mainly mortality as the outcome) were published (Table 1). 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21”
  • The large number of individual validation studies provided the basis for 10 systematic reviews, some including meta-analyses, exploring different aspects and settings of GLIM published through March 5, 2024.

    “The large number of individual validation studies has provided the basis for 10 SRs, some including meta‐analyses, exploring different aspects and settings of GLIM (Table 1) published through March 5, 2024.”
  • The corresponding hazard ratio for beyond 1-year mortality was 2.04 (95% CI, 1.70-2.45).

    “The corresponding HR for “beyond 1‐y mortality” was 2.04 (95% CI, 1.70–2.45).”

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  1. [41]Hiraike T Momoki C Habu D. Comparison of the adequacy of geriatric nutritional risk index with that of the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a single-institutional cohort study. BMC Geriatr. (2023) 23: 35. doi: 10.1186/s12877-023-03740-5 36670357 PMC9854135 · DOI

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Authors
Bian, W., Li, Y., Wang, Y., Chang, L., Deng, L., Li, Y., Jiang, H., & Zhou, P.
Affiliations
Chengdu University of Traditional Chinese Medicine (CN)
Corresponding author
  • Jiang, Hua
  • Zhou, Ping
Venue
Frontiers in Nutrition
Published
2023-07-04
Volume
10
Pages
1174945-1174945
ISSN
2296-861X (ISSN-L)
OpenAlex
W4383103383
Cited by
47
References
92
Citations by year
2026: 20 · 2025: 15 · 2024: 11 · 2023: 1
FWCI
1.68
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Nutrition (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
malnutrition, malnutrition prevalence, nutritional risk screening, NRS-2002, Mini Nutritional Assessment, hospitalized adults, cancer patients, critically ill patients, diagnostic accuracy, nutritional assessment tools, chronic disease, children and adolescents

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